“This is one of those days you’ll remember all your life,” I asserted to Cheryl as we followed a circuitous red line. St. Joseph hospital has turned the SARS-CoV-2 vaccination process into a smoothly running machine.
The needle stick itself, as with all vaccinations, lasted 3 seconds, the least arduous element. Sitting down and exposing my left deltoid was a relief after the verification of my appointment time and identity, provision of documents, and much finger-pointing at where to go next. Afterwards, we proceeded to sign and return said documents, and create the golden second-dose appointment, three weeks hence. “The bureaucratization and businessifcation of medicine”, one of my friends from the ‘80s called it whenever he encountered a barrier between him and those he cared for. I’ll take it if we can get on to a new normal, or at least less fear, by the end of March.
I went to sleep last night worrying about the vaccine’s efficacy. Sure, it works great at preventing serious illness, but it’s only been tested in an environment where 85%+ of the population is masked, many people avoid crowds and prolonged exposure to others indoors. What happens when those restriction are lifted, or people’s behavior changes as they feel safer? There are no answers to that question, as this has never been tried before. How often have we said that in the past year?
This morning, after an active hour at breakfast with my grand-daughter Neva, I began to feel fatigued. I did not attempt my morning exercise routine, nor was I able to complete all the elements of something as simple as brushing me teeth – admittedly a four-part, 12-minute process for me.
“I don’t know, I’m feeling tired,” I announced to Cheryl. “I think I’ll try lying down.” I would miss Neva’s walk to feed a carrot to the sway-backed horse next door, and watching her float on the new swing seat we’ve installed on the wooden 35 year-old Big Toy.
I spent an hour not only lying down, but sleeping, stronger and longer than a nap. Still tired when I woke up, I decided I had to know – how safe am I/will I be?
I explored the web a bit for some accurate data from the phase 3 trial, not distillations in the general press, nor opinions of medical experts who might have a bias even they don’t recognize, much less acknowledge.
Hmm…forty pages of briefing materials for the FDA committee meeting? Too jargon-y, and the data well hidden within the florid verbosity. CDC press release after emergency approval? Too vague and incomplete, meant primarily to offend no one and encourage caution. A British Medical Journal editorial burrowing deep into the unpublished numbers behind those released, trying to convince us that the true facts were being hidden and the vaccine is only 19%, not 95% efficacious? Too biased, and the comments section filled with views of other experts on the entire 360 degree spectrum, all of whom were convinced they and their equations were definitive.
Finally, I went to the most trusted source I knew, the New England Journal of Medicine. At least the article would be short, boring, and written in a language I could understand – dense, filled with Latinates, the way doctors talk to each other when no one else is listening. I discovered two valuable results.
First, those who received the vaccine, compared to those who got saline in their shot, were 3 times more likely to have fatigue in the days after their injection, the majority of them “moderate”, as distinct from “mild”. Reassuring. My ever-positive mind immediately assumed that those who felt tired in the day or two after their shot were mounting a strong immune response, which required substantial energy to build new antibodies quickly and encourage T-cell recognition. That doesn’t mean someone with no fatigue will produce no immune response. They might be building it at a more stately rate. We’ll know the answer to this in a year or two, when we can compare those with fatigue vs those without, and see if they had different rates of subsequent illness from infection with SARS-CoV2.
Second, a small chart in the Results section gave me more reassurance than anything else I’ve heard in this pandemic. If you examine the graph up top, observe the red line, which flattens dramatically after paralleling the blue line for about 10 days. Red represents those in the study who received the actual vaccine; blue shows those who got the placebo. The dots reflect the cumulative number in each group who had become infected with the virus up to that date. On the left side, the Y-axis, are the number of cases, shown as the percent of total participants. At the bottom, the X-axis, are the number of days after receiving the first dose. Note the inset showing the first three weeks on the left.
That flattened red line, dropping dramatically below the blue line as the days proceed, is saying that after 10-14 days, almost no new cases of COVID-19 appear. The popular message as been about 50% effective with the first dose, and 95% with the second, The actual data are: 8 out of 21,720 vaccinated people got infected during the study after the first week. The comparable number for the unvaccinated was 162/21,728. More important, those not vaccinated kept getting infected at a steady rate, while those vaccinated saw a sharp drop-off in the infection rate after 2 weeks or so.
In more practical, terms, your risk of getting infected if you don’t get vaccinated is 20 times greater than if you are. And, the vaccine will begin to express its prevention power within 10-14 days after you get it.
[Now about that “95%” – remember, the study so far is only 3 months long. Percentage efficacy will drop, the longer out from the time of vaccination. We have no idea what this will mean, as we don’t know how long the virus will be widely circulating in the community, nor how long the vaccine-induced antibodies will remain effective in fighting the virus. If the virus exits society faster than we individually lose immunity, all’s well. Other way around, we might have to get periodic boosters.]